O'brien v. Kobrin
| Decision Date | 11 April 2000 |
| Docket Number | CV9600968 |
| Citation | 2000 MBAR 119 |
| Parties | Shawn E. O'Brien et al. v. Kennard Kobrin |
| Court | Massachusetts Superior Court |
Mass L. Rptr. Cite: 11 Mass. L. Rptr. 593
Judge (with first initial, no space for Sullivan, Dorsey, and Walsh): BRASSARD
The estate of Diane O'Brien filed the present action against the defendant Kennard Kobrin, a psychiatrist at the John C Corrigan Mental Health Center, alleging wrongful death and civil rights violations in connection with O'Brien's suicide on July 14, 1993. This matter is before the court on the defendant's motion for summary judgment pursuant to Mass.R.Civ.P. 56. For the reasons discussed below, the defendant's motion is DENIED.
The undisputed facts as revealed by the summary judgment record are as follows. On July 9, 1993, Diane O'Brien (O'Brien), a thirty-five-year-old mother of three, was involuntarily committed as a substance abuser to the Stanley Street Treatment & Resources Rehabilitation Program (SSTAR) by the Taunton District Court pursuant to G.L.c. 123, 35. (Commitment Petition.) O'Brien was addicted to cocaine and barbituates, had stolen checks from her parents in order to obtain drugs, and was focused on attempts to obtain prescription medications. (Commitment Petition.) In addition O'Brien was depressed, had been raped a week prior, and had recently made numerous suicide attempts and suicide threats.
On July 11, 1993, O'Brien reported to the SSTAR nursing staff that she was suicidal and was hearing a man's voice stating that he was going to kill her. SSTAR's procedure when a patient appeared suicidal was to send the patient to a secure facility such as the John C. Corrigan Mental Health Center (Corrigan), a Department of Mental Health facility located in Fall River. (Garvey Depo. p. 202.) SSTAR contacted Corrigan and requested a psychiatric evaluation of O'Brien "for safety." (SSTAR Request.) Corrigan Outreach Worker Kathleen Frias (Frias) went to SSTAR to evaluate O'Brien. Frias observed that O'Brien was anxious, crying and sobbing. O'Brien stated that she was hearing voices, that the voices were driving her crazy, and she couldn't take it anymore. (Frias Interview Notes; Price Letter p.2; OIA Report p.13.) Frias noted that O'Brien was not in control of the voices and that if they intensified, she might hurt herself by acting out on them. (Frias Interview Notes.) Frias concluded that O'Brien should be evaluated by a psychiatrist for suicidality and medication for the auditory hallucinations and a possible inpatient hospitalization. (Frias Depo. p. 137; Faria Depo. p. 26.) Accordingly, O'Brien was transported to Corrigan for a risk assessment evaluation. (Farrelly Depo. p. 4; OIA Report p. 14.)
Corrigan's mandate was to examine the patient, determine what treatment was required, and ensure the patient's safety using the least restrictive measure possible. (Farrelly Depo. p. 32.) Daphne Saalmon (Saalmon) was the Crisis Clinician on duty at Corrigan on July 11, 1993. Saalmon, who had a masters degree in social work, had graduated from school in 1992 and had only been employed at Corrigan since June of 1993. (Farrelly Depo. p. 37; Moss Depo. pp. 13- 14.) Based on the information received by Frias, Saalmon believed that O'Brien should be evaluated by a psychiatrist. (Faria Depo. pp. 71-72.) However, it was beyond Saalmon's level of skill and training to assess O'Brien's suicidality and make a determination as to whether she required hospitalization. (Farrelly Depo. pp. 38-39.)
Saalmon telephoned the psychiatrist on call, Dr. Kennard Kobrin (Kobrin) and told him that Frias believed O'Brien might need admission to the hospital. (Haltzman Depo. p. 51; OIA Report p. 14.) Kobrin informed Saalmon that it was SSTAR's responsibility to provide O'Brien with psychiatric services and that he could not admit O'Brien under G.L.c. 123, 12 because she was currently committed to SSTAR as a substance abuser under c. 123, 35. (Haltzman Depo. pp. 51-52; Price letter p. 3.) Although Saalmon told Kobrin that 35 patients had been admitted to Corrigan in the past, he insisted that such admission would be illegal. In fact, Kobrin was mistaken and such a hospitalization was legally possible. (Isaacson Letter 7/27/93.) Kobrin had worked for some time in forensic mental health, including at Bridgewater State Hospital, and was considered to have expertise in forensic mental health issues as well as in-depth knowledge of the policies and application of 35 and the interplay between 12 and 35. (Haltzman Depo. p. 128.) Kobrin later admitted to Department of Mental Health Investigator David Faria that he could in fact have hospitalized O'Brien under 12 if necessary. (Faria Depo. pp. 23-24.)
Kobrin was required to make a determination about whether he needed to examine the patient in person, or whether to give phone orders or other consultation to the crisis clinician. (Farrelly Depo. p. 36.) He would be legally required to come to the hospital for an in-person psychiatric evaluation of a patient if there were a court order for apprehension or in the case of a G.L.c. 123, 12 admission. (Faria Depo. pp. 12-13.) Kobrin decided not to come to Corrigan to evaluate O'Brien in person. Kobrin suggested that Saalmon evaluate O'Brien and then call him back for evaluation. (Price letter p. 3; OIA Report p. 15.)
Saalmon met with O'Brien for approximately half an hour and conducted a mental status assessment. (Haltzman Depo. p. 40; Farrelly Depo. p. 30.) Saalmon noted that O'Brien presented with visible psychomotor agitation, shaking; that she had a history of depression and was presently feeling depressed. (Farrelly Depo. pp. 35-36; Screening Instrument pp. 3-4.) Saalmon noted that O'Brien had expressed a desire to kill herself by hanging earlier in the day, but stated that she did not presently feel suicidal. (OIA Report p. 15.) When Saalmon asked O'Brien about her auditory hallucinations, O'Brien stated that she had been hearing a man's voice stating, "I'm going to kill you." (Farrelly Depo. p. 52.) However, O'Brien denied hearing voices at that moment and stated that SSTAR had decreased her Klonopin which she needed to help control the voices. (OIA Report p. 16.) Saalmon noted that O'Brien was focused on a recent rape and was seeking medication. (Screening Instrument p. 4.) Saalmon believed that O'Brien could contract for her safety and let staff know if she were feeling suicidal. (Price letter p. 3; Screening Instrument p. 5.) O'Brien agreed to contract for her safety. (OIA Report p. 16.)
Saalmon then consulted with Kobrin by telephone, informing him of what transpired in the interview and that O'Brien had contracted for safety. (OIA Report p. 16.) Kobrin believed that O'Brien did not require hospitalization and told Saalmon that he felt medication was the issue. (OIA Report p. 16.) The staff physician at SSTAR had ordered that O'Brien's Klonopin be tapered off. (Faria Depo. p. 67.) Kobrin spoke to the charge nurse at SSTAR, who stated that O'Brien had indicated that she did not want her Klonopin further decreased and that in the past, Thorazine had been helpful in controlling her auditory hallucinations. (Haltzman Depo. p. 50.) Kobrin believed that the best way to address the auditory hallucinations was to increase O'Brien's Thorazine; however, he also had some concern that O'Brien was seeking medication, because Klonopin, a substance similar to valium, would not affect the hallucinations. (Faria Depo. pp. 145-46.) Ultimately, Kobrin recommended that O'Brien receive a dose of 50 milligrams of Thorazine and that she not be tapered any further off her Klonopin. (Haltzman Depo. p. 50.)
O'Brien was then transported back to SSTAR. The staff at SSTAR had received information from Corrigan that O'Brien was "med-seeking" and that it was safe for her to return to SSTAR. (Ward Depo. p. 48.) A SSTAR physician, Scott Haltzman (Haltzman), increased O'Brien's dosage of Thorazine but reduced her dosage of Klonopin, apparently unaware of Kobrin's instructions to maintain it. (O'Brien Inter. 4; Ward Depo. p. 48.) The following day, July 12, Frias spent approximately 15 minutes with O'Brien. She was surprised to see O'Brien at SSTAR because she believed that O'Brien was going to be admitted to Corrigan. (Frias Depo. pp. 97-98.) O'Brien reported that she was extremely anxious, depressed, and upset that her Klonopin was being reduced. (O'Brien Inter. 4.) On July 14, 1993, O'Brien was extremely anxious and told staff she needed medication and "couldn't take it anymore." (Police Report.) That same day, O'Brien committed suicide by hanging herself on the shower curtain rod in a bathroom at SSTAR. (Autopsy Report.)
Thereafter, on July 5, 1996, O'Brien's estate filed the present wrongful death action against Haltzman and SSTAR. On May 11, 1999, the estate moved, without opposition, to amend its complaint to add claims against Kobrin, and the motion was allowed on May 18. Count I of the amended complaint alleges negligence against Haltzman, Count II alleges negligence against SSTAR, Count III alleges negligence against Kobrin, and Count IV alleges that Kobrin violated 42 U.S.C. 1983. The estate settled its claims against Haltzman and SSTAR and in June of 1999, the estate stipulated to the dismissal with prejudice of Counts I and II of the complaint.
Kobrin was employed by the Commonwealth of Massachusetts Department of Mental Health at its Corrigan facility as a Psychiatrist III from July of 1987 until January of 1998. (Kobrin Aff. 1.) Kobrin was paid a fixed salary by the Department of Mental Health. (Kobrin Aff. 9.) He was supervised by the Medical Director, who completed an annual Employee Performance Review Form rating Kobrin's performance. (Personnel Form Performance Review Form; Kobrin ...
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